WHO launches global initiative for arboviral diseases
Authors: Vijay Shankar Balakrishnan
Journal: The Lancet Microbe (2022)

WHO has announced a new initiative to monitor and control arthropod-borne viral diseases. Launched on March 31, 2022, the Global Arbovirus Initiative aims to “raise the global alarm on the risk epidemics of arboviruses and potential risk of pandemics,“ writes a WHO spokesperson in an email to The Lancet Microbe, “it provides a list of priority actions that countries and regions can implement to be prepared for the next arbovirus outbreak. “WHO Director–General Tedros Adhanom Ghebreyesus first presented the idea of this initiative at the Health Security Council in 2019, when some countries were facing severe dengue epidemics and the emergence of other arboviruses such as chikungunya and Zika was well-documented. WHO prepared the first draft of the initiative in December that year but, because the COVID-19 pandemic took priority, the UN waited until November 2021 to discuss the concept and execution of this initiative. By December 2021, the WHO Technical Advisory Group on Arbovirus (TAG-Arbovirus) proposed the initiative as an integrated approach that aims to collate the crucial components of the detection, prevention, and control of arboviruses. “This initiative will enable the optimal use of limited resources to achieve the greatest impact, particularly in areas with the heaviest arboviral burden and co-circulation of multiple arboviruses,“ the WHO spokesperson said. The initiative is under the umbrella of the WHO Triple Billion Targets, and it is complementary to the Eliminate Yellow Fever Epidemics strategy, Global Vector Control Response Initiative, and the Neglected Tropical Disease Roadmap. It is designed to monitor and control arboviral diseases on a global scale using six pillars: to monitor in real-time and anticipate the risk of arboviral epidemic or a pandemic; mobilise resources to reduce epidemic risk; strengthen vector control (particularly in cities); prevent and prepare for pandemics; accelerate innovation in insect control methods or development of new diagnostics, drugs, and vaccines; create and support new approaches towards vector control; and build a coalition of a partnership between stakeholders that could extend and receive support to improve the control of arboviral diseases. “The next pandemic could very likely be due to a new arbovirus, and we already have some signals that the risk is increasing,“ said Sylvie Briand (WHO Director of Pandemic and Epidemic Diseases) during the launch event. “Since 2016, more than 89 countries have faced epidemics due to the Zika virus. Given human mobility and urbanisation, the risk of amplifying localised arbovirus outbreaks is real.” The initiative is welcomed by Maria Anice Mureb Sallum (University of São Paulo, São Paulo, Brazil), but she is worried that the six pillars of the initiative neither address how poverty increases the risk of arboviral infection nor how to eradicate poverty to prevent infections. “In Brazil, we see people collecting trash and recycling it to earn their living, but where they collect the garbage is a source of several arboviral diseases,“ Sallum said. “Mosquitoes thrive there, and the poverty linked with these petty jobs should have a place on one of the six pillars, but it hasn’t been included.“ There is also a concern that the initiative might not be sustainable in the long term. According to Gabriel Zorello Laporta (Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil), “the six pillars of this initiative are good, but global politics nowadays have to deal with regions and countries that do not care about international agencies such as the UN or WHO, so the real challenge is in convincing such countries to commit to this initiative,“ said Laporta. He also added that WHO should have “achievable goals [rather] than unrealistic targets in arboviral disease control. “For both Sallum and Laporta, the global initiative must include a local perspective and the correct representation of expertise. “We need to have more women and indigenous populations in the talks because it's impossible to have one disease control programme for the whole country, be it arboviral diseases or any other diseases,“ Sallum said. “Integrated approaches should really integrate such people, their issues and expertise beyond involving researchers and decision makers to reflect true community engagement as they advertise in this initiative“. TAG-Arbovirus has members from Australia, Brazil, Cuba, France, Ghana, India, Iran, Malaysia, the Netherlands, Portugal, Singapore, South Africa, Sri Lanka, Sudan, Venezuela, and the USA with expert representation from low-income and middle-income countries that are disproportionately affected by arboviral diseases in comparison with high-income regions. This representation should reassure concerns of under-reprensentation of relevant countries in this global health initiative. “We know how important it is to include the views of many stakeholders, including community members, which is why the global consultations were done including stakeholders from all the regions, and the TAG-Arbovirus has members from all regions,“ the spokesperson said. “WHO ensures that in our technical groups—related and non-related to this initiative—all the regions are represented equally, and all voices are being heard in the discussions.“ The next steps involve WHO updating their arboviral technical tools and guidance, including hotspot mapping, and working with local partners to strengthen surveillance and prevention activities.